Provider Demographics
NPI:1770099764
Name:BRIGHT, GRANT TALOR (PHD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:TALOR
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 PEACH MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8884
Mailing Address - Country:US
Mailing Address - Phone:678-400-2188
Mailing Address - Fax:
Practice Address - Street 1:2205 OLD HAMILTON PL STE 400
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-8052
Practice Address - Country:US
Practice Address - Phone:678-400-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional